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Direct ventriculoatrial shunt in a pediatric patient: case report and technical note
Cyril S Tankam1, Varun Padmanaban2, Julia Pazniokas3
1Department of Neurosurgery, Penn State Hershey Medical Center, Penn State Children's Hospital, 30 Hope Drive, Suite 1200, Building B, Hershey, PA, 1733, USA. ctankam@pennstatehealth.psu.edu.
Summary
Direct cardiac shunts offer a safe option for pediatric hydrocephalus when other methods fail. Technical considerations for placement, like sternal divots, aid long-term function in growing children.
Area of Science:
- Neurosurgery
- Pediatric Cardiology
- Biomedical Engineering
Background:
- Direct cardiac shunts were historically used in pediatrics but are less common today.
- This case highlights the re-emergence of direct ventriculoatrial shunts for complex hydrocephalus.
- Silastic catheters have since been introduced, improving shunt technology.
Observation:
- A 2-year-old patient with multiple congenital abnormalities presented with recurrent shunt malfunctions.
- Conditions included tracheal atresia, atrioventricular septal defect, and hydrocephalus requiring shunting.
- Previous shunt placements failed due to abdominal malabsorption and infections.
Findings:
- Direct ventriculoatrial shunt placement was chosen as the safest option due to the patient's complex anatomy.
- Technical nuances, including creating a sternal divot, were employed to accommodate growth.
- A multidisciplinary team approach is crucial for successful placement.
Implications:
- This case demonstrates the feasibility and safety of direct cardiac shunt placement in select pediatric cases.
- Consideration for linear growth is vital when planning shunt placement in children.
- Direct cardiac shunts may be a viable alternative for complex hydrocephalus management.
